May 5, 2017
LUSAKA, ZAMBIA — At Chipata Clinic in Zambia’s capital, Lusaka, Fred Mwansa concludes his session with a group of HIV-positive people on how they can use the short messaging system (SMS) to anonymously access information on HIV counseling, treatment, prevention and care.
He then distributes scratch cards of 2 Zambian kwacha (25 cents) in mobile phone credit to his clients.
No sooner has Mwansa retreated than sounds of beeps, vibrations and ringtones of all sorts are heard as his clients try out the short messaging system.
“You see,” Mwansa says, referring to the ringtones, “there is instant feedback. It may not be the answer to your questions, but the message that comes immediately when you send a query is to assure you that you will receive the utmost attention, that you will receive feedback in not less than 24 hours.”
Mwansa promotes the End AIDS Portal that uses SMS to spread information on HIV/AIDS counseling, prevention, adherence to treatment, nutrition, prevention of mother to child transmission and cervical cancer. It also can remind users about keeping their medical appointments.
Prudence Phiri, GPJ Zambia
Civil society group Treatment Advocacy and Literacy Campaign (TALC) initiated the End AIDS Portal in 2013 because of a shortage of health care workers and the prevalence of HIV in the nation. The Joint United Nations Programme on HIV and AIDS (UNAIDS) says 1.2 million out of Zambia’s population of 17 million live with HIV.
Zambia’s Ministry of Health recognizes the shortage of health workers. Dr. Kennedy Malama, a ministry spokesman, says the country needs 61,000 health workers at a minimum but has only 49,000 — a deficit of 12,000.
The World Health Organization attributes the shortage in Zambia to inefficient management due to highly centralized decision making, large attrition rates from preservice training, inadequate funding of training institutions and lack of teaching staff. It also notes a high rate of health worker mortality due to HIV/AIDS.
Because of the shortage, “people had a lot of questions. But because of congestion at health institutions, things are hastily done to clear the crowd,” says TALC director Felix Mwanza. TALC advocates for equitable and sustainable access to treatment and care for people living with HIV and AIDS in Zambia.
Mwanza says the SMS portal is a way to help the country achieve the 90-90-90 UNAIDS target by 2020. The 90-90-90 target states that by 2020, 90 percent of those living with HIV will know their HIV status, 90 percent of those diagnosed with HIV will receive sustained antiretroviral therapy, and 90 percent of those receiving antiretroviral therapy will have viral suppression.
“When designing this, we had a person living with HIV in mind,” Mwanza says. Trained responders are ready to answer questions about medicine, side effects and many other issues, he says. “There is also a technical adviser who is qualified medical personnel to answer technical questions.”
Elizabeth, an HIV patient who, for fear of stigma, asked that only her first name be given, says she has been using the End AIDS Portal since 2015, and she describes it as effective.
“Sometimes I have pressing questions, and time can’t allow me to go to the health center,” she says. “Even if I had the time, the queues are just crazy. So I find the SMS system very effective, because I receive feedback in less than 24 hours.”
Timekenji Daka, who also is HIV positive, says the portal makes information about HIV accessible anywhere and anytime.
“For me, it’s the best news ever; anyone can access information anywhere,” she says.
Anybody with access to a mobile phone on any of the three networks, MTN, Zamtel or Airtel, can send an SMS to 3401 at a cost of 0.6 Zambian kwacha (6 cents) per message from any part of Zambia, says Maureen Phiri, a promoter of the End AIDS Portal.
More than 50 people send SMSs to TALC every day, she says.
The End AIDS Portal can remind clients of appointments at health facilities.
“Two or three days before their appointment date at the clinic, they will receive an automated message to their phone reminding them of their appointment,” she says. “This way, no one misses an appointment with the health care providers.”
Mwanza says the agents that respond to the SMSs encourage clients to visit the health centers. The system is not designed to replace regular visits with health care workers.
“Our job is not to prescribe or tell people what to do,” he says. “Our job is just to ensure that we provide a link between ourselves and the health facility and encourage them to visit their health provider. The questions asked are answered based on the recommendations of the national treatment guidelines.”
Although anyone from any part of the country can communicate with TALC via the SMS, Mwanza says, the promotion is currently concentrated on Lusaka.
“We are rolling out to other provinces soon, so that everyone can have full knowledge about the service,” he says.
The Health Ministry’s Malama says TALC’s work is commendable in providing information but doesn’t replace the need for health workers to give specialized attention to client questions.
“TALC is one of the key players we have in the HIV intervention in terms of HIV prevention, treatment, care, support, the whole response to HIV,” Malama says. “They are our strategic partners, but health workers need to play their role too.”
Health workers, he says, “need to thoroughly attend to patients, despite the shortage of human resources. Let patients get individualized attention; rushing through to clear a queue defeats the purpose of health care service.”
EDITOR’S NOTE: GPJ’s Prudence Phiri and Maureen Phiri are not related.